Provider Demographics
NPI:1891949145
Name:KIDADA HOLLOWAY
Entity type:Organization
Organization Name:KIDADA HOLLOWAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KIDADA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:828-582-1688
Mailing Address - Street 1:415 CHUNNS COVE RD APT 200B
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28805-1035
Mailing Address - Country:US
Mailing Address - Phone:828-582-1688
Mailing Address - Fax:
Practice Address - Street 1:415 CHUNNS COVE RD APT 200B
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805-1035
Practice Address - Country:US
Practice Address - Phone:828-582-1688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6585101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty